Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, January 10, 2024

Funny How Your Past Can Come Back All In A Rush! A Good Reminder Of Times Past.

 I noticed this a day or so ago.

Colorful Mystery Solved: Scientists Discover Enzyme That Makes Urine Yellow

Finding Could Illuminate Future Studies of Gut Health and Inflammatory Bowel Disease

Researchers at the University of Maryland and National Institutes of Health have identified the enzyme responsible for giving urine a yellow hue, and it’s more than a matter of idle curiosity or grade-school giggles.

The microbial enzyme known as bilirubin reductase was introduced in a study published Wednesday in the journal Nature Microbiology, paving the way for further research into the gut microbiome’s role in ailments like jaundice and inflammatory bowel disease.

“It’s remarkable that an everyday biological phenomenon went unexplained for so long, and our team is excited to be able to explain it,” said lead author Brantley Hall, an assistant professor in UMD’s Department of Cell Biology and Molecular Genetics.

When red blood cells degrade after their six-month lifespan, a bright orange pigment called bilirubin is produced as a byproduct. Bilirubin is typically secreted into the gut, where it is destined for excretion but can also be partially reabsorbed. Excess reabsorption can lead to a buildup of bilirubin in the blood and can cause jaundice—a condition that leads to the yellowing of the skin and eyes. Once in the gut, the resident microorganisms can convert bilirubin into other molecules.

Lots more here:

https://today.umd.edu/colorful-mystery-solved-scientists-discover-enzyme-that-makes-urine-yellow

Reading this I was reminded that 50 years ago I was also interested in bilirubin and its damaging effects on premature neonates. The high bilirubin levels were a marker of an immature metabolism and very high levels often warned of a poor outcome, and a nasty syndrome called kernicterus, which is associated with mental impairment.

I was reminded of this VERY old paper:

Clin Chem  1975 Oct;21(11):1638-43.

Fluorometric determination of "albumin-titratable bilirubin" in the jaundiced neonate

S B McCluskeyG N StoreyG K BrownD G MoreW J O'Sullivan

  • PMID: 1164793

Abstract

We report a fluorometric technique for determination of albumin-titratable bilirubin in the jaundiced neonate. Although bilirubin alone has very little native fluorescence, considerable emission is observed in the presence of albumin under acid conditions. Analysis of the plasma sample alone and in the presence of excess human serum albumin solution appears to reflect the bilirubin tightly bound to albumin and the total serum bilirubin, respectively. The difference between these two values has been designated as "albumin-titratable bilirubin". Where the concentration of albumin-titratable bilirubin is considerable, a typical saturation effect is observed. In samples where the circulating bilirubin is strongly bound to endogenous albumin, no change in fluorescence is seen when exogenous albumin is added. Results correlate well with the clinical picture.

Here is the link:

https://pubmed.ncbi.nlm.nih.gov/1164793/

In the 50 years since this work was done it really seems that the importance of neonatal jaundice and what to do about it is well established and that has to be a very good thing!

I have had a quick browse to find a current reference site and this looks like a great place to start and to see how things have moved on since I was first interested!

https://www.ncbi.nlm.nih.gov/books/NBK532930/

Neonatal Jaundice

Betty Ansong-Assoku; Sanket D. Shah; Mohammad Adnan; Pratibha A. Ankola.

Author Information and Affiliations

Last Update: February 20, 2023.

Great to see progress really does happen, and from all over! I certainly can’t take any credit!!!!

Hoping Digital Health news ramps up soon!

David.

Sunday, January 07, 2024

It’s 2024 And It Seems Like The Hackers Are Still Winning. For How Much Longer?

This appeared a few days ago:

Low cost, high reward: The hackers holding Australia to ransom

By David Swan and Colin Kruger

January 6, 2024 — 5.00am

If the skull and crossbones wasn’t already threatening enough, the accompanying message made the situation clear.

“If you see this text, then your files are no longer accessible, because they have been encrypted” was the text that greeted workers when they switched on their computers at Cadbury’s factory in Hobart. “Perhaps you are busy looking for a way to recover your files, but don’t waste your time. Nobody can recover your files without our decryption service.”

The Petya ransomware attack in June 2017 halted chocolate bar production in Hobart and ultimately cost Cadbury’s parent company, Mondelez International, an estimated $140 million in lost revenue. It was also among the first of what has become an avalanche of ransomware attacks to hit Australian businesses, which industry insiders say are chronically underprepared to deal with such incidents.

St Vincent’s Health and Court Services Victoria recently joined the fast-growing list of high-profile organisations scrambling to respond to debilitating cyber incidents, which have by now impacted almost every Australian.

The attacks are not an outlier but are instead a “new normal”, according to cyber professionals, who say a cultural shift is needed more than any new suite of technical defences. They say Australia was never a primary target for cybercriminals until recently, and they hope the recent spate of attacks will serve as a belated wake-up call after years of a lack of interest and underinvestment.

Jamieson O’Reilly is the founder of cybersecurity firm Dvuln, which Australian companies and government agencies pay to find IT vulnerabilities. “Security in Australia is by and large still considered a grudge purchase,” O’Reilly says. “We need a cultural shift.”

A 17-year-old can pay less than $100 to gain access to an infected computer belonging to an employee of a billion-dollar company, according to O’Reilly, and the balance of power now rests squarely with the hackers.

While the idea of a teenage “script kiddie” – a novice hacker using unsophisticated tools – might seem like the stuff of a bad 1990s movie, the threat to some of Australia’s biggest businesses is very real.

“Optusdata”, the anonymous hacker who in late 2022 made away with the personal data of more than 10 million Optus customers before backing down from a $1.5 million ransom threat, was described as “unprofessional” and “stupid” by their hacker peers on the dark web.

The Optus mass data breach occurred through an unprotected and publicly exposed end point, meaning anyone who discovered it could connect to it without submitting a username or password. The attack was far from sophisticated, according to O’Reilly and other experts.

“For attackers, especially those utilising low-cost, high-reward strategies, the investment is minimal compared to the potential pay-off, which can range from financial gain to significant data breaches – or even reputational damage to the targeted organisation,” O’Reilly says.

According to the Australian Signals Directorate, an intelligence agency, more than 127,000 hacks against Australian servers were recorded between the 2022 and 2023 financial years. This marked an increase of more than 300 per cent over the prior year – and O’Reilly says that matches what he’s seeing on the ground. 

In the shadows

O’Reilly spends much of his time monitoring the dark web, which ransomware groups use to leak data and boast about their bounties. He regularly reports his findings to the Australian Signals Directorate.

The dark web is a shadowy part of the internet accessible only through special software, allowing users to remain anonymous. It is commonly used for illegal activities such as buying and selling drugs and weapons, as well as stolen credentials.

The group suspected to be behind the 2022 Medibank data breach, Russian cybercriminal gang REVil, posted customer names, birthdates and Medicare details under “good” and “naughty” lists on its dark web site named Happy Blog. The leaked data included patients who had undergone treatment for drug addictions and terminated non-viable pregnancies.

“I recommend to sell Medibank stocks,” the group said in the post, along with a quote from Confucius: “A man who committed a mistake and doesn’t correct it is committing another mistake.”

A person claiming to be the Medibank hacker told this masthead in broken English via email during the incident that they would have not leaked the stolen data had the company paid up. Medibank publicly ruled out paying the hackers the $US9.7 million ($14.5 million) they demanded, and the federal government had also advised against payment.

The government is currently weighing a total ban of ransomware payments, though company directors say the payments may be justified to avoid catastrophic outcomes.

“We do business in our way, and we never targeted any particular people for that – only companies,” the purported hacker said via email.

“We ask a similar price, as on blackmarket for that detailed data about Medi customers. And where Medi refuses to pay – we should earn some money, to cover our efforts. Talking that way, Medibank in fact forces us, to sphread [sic] customers data.”

With attacks surging, the federal government is under increasing pressure to help organisations defend themselves. Cybersecurity Minister Clare O’Neil described financially motivated hackers and extortionists as “public enemy No.1” when she launched the government’s new cyber strategy late last year.

O’Neil said Australia faced the most challenging circumstances since the Second World War, and that cybersecurity would be integral to how the events of the coming decade played out.

‘A good start’

The federal government’s “six shield” strategy includes $291 million in support for small and medium-sized businesses, including the creation of a cyber health-check program offering free and tailored cybersecurity assessments to business owners. It has a stated goal of making Australia the world’s safest cyber nation by 2030.

Many cybersecurity professionals aren’t convinced that’s possible but acknowledge it’s a goal worth pursuing.

“What Claire O’Neil and the current government have been doing is a good start, but it’s been attempted before, and we need to ensure it survives future political changes. Cybersecurity is no longer a nice to have; it’s a fundamental component of everything we do,” O’Reilly says.

He says Australia needs to find a way to ensure cybersecurity strategies are consistent across jurisdictions and are not beholden to the government of the day.

“One thing we can learn from our so-called ‘adversaries’, the people hacking us, is that consistency is key.”

In late 2022, in response to the Optus and Medibank breaches, the parliament passed legislation that can result in businesses being fined $50 million for repeated or serious data breaches.

Tony Burnside, head of Asia Pacific at cybersecurity giant Netskope, says we should be encouraged that Australia has a hands-on and proactive government when it comes to cybersecurity.

“The new cybersecurity strategy, which I think we can say has been well received overall, focuses on the right issues that need to be addressed now, and will act as a good framework for new legislation that will help Australian organisations and individuals be more secure,” he says.

“Our global alliances, especially in the context of AUKUS, also equip us with solid offensive and defensive state cybersecurity capabilities.

“Some organisations and parts of the populations are still fairly vulnerable compared to other countries, though... We weren’t exactly a primary target for cybercriminals until recently, and this has created some complacency and a feeling that major cyberattacks wouldn’t occur here.

“In the past 18 months there has been a wake-up call.” 

Bolstering the defences

Netskope’s most-recent threat report found the majority of cyber threats targeting Australian organisations were criminally motivated, with only 12 per cent of attacks having a geopolitical motivation. Both the Medibank and Optus hackers demanded millions in ransom payments.

At Medibank’s shareholder meeting in November, chairman Mike Wilkins emphasised that the private health insurer had ramped up its security.

“The board has been overseeing a group-wide program of work that aims to continue uplifting and embedding the technology, processes and security culture within Medibank to support our customer promise of being a trusted health partner,” he said.

Port operator DP World, another recent hacking victim, is improving its security as well.

“We undertook a thorough review of our security controls with the assistance of third-party cyber expertise,” a spokesman says.

“In order to reduce the likelihood of similar incidents occurring, we are working through a cyber remediation plan to implement additional controls, limit access to external applications to certain addresses and countries only, implement additional end-point and network detection and response capabilities.”

CBA chief Matt Comyn said the bank was “conscious of and spend a lot of time, effort and resources on issues such as cybersecurity given the risks presented by such threats nationally and globally”.

“We’ve already seen a number of examples of how damaging a breach of cybersecurity can be and that is a warning to us all to take the necessary and vitally important steps to protect ourselves from these increasing attacks,” Comyn said.

But some of Australia’s biggest companies such as IAG, the insurance group behind brands like NRMA Insurance, CGU, SGIO, are not waiting for hackers to come knocking.

“We take cyber and data risk very seriously and we continue to invest heavily in this area,” says IAG’s chief risk officer, Peter Taylor.

“We are also an active participant in broader industry and government initiatives to enhance cyber resilience more generally.”

Cybersecurity provider CyberCX is working with St Vincent’s Health to remediate and respond to its recent cyberattack. It’s still unclear whether any sensitive health data was stolen in that attack, which people close to the investigation say was likely financially motivated. The company is also working with the Australian Open to safeguard the coming tournament. 

All organisations at risk

The Medibank and St Vincent’s Health data breaches were facilitated through compromised staff accounts, according to investigators. Hackers typically compromise accounts through social engineering or phishing attacks – emails that seem legitimate and encourage users to enter their login information.

All Australian organisations are at risk, according to CyberCX’s financial services and insurance industry director, Shameela Gonzalez.

“More than green text on a black screen, executives are anxious about the 2am phone call, or the contact from a customer instead of catching it themselves,” Gonzalez says.

“It’s the combined challenge of scrambling to understand what has happened, re-securing systems without inflicting more damage, and communicating effectively in a matter of hours … It’s a tough ask, even before you consider that someone out there is working just as hard to do you harm.

“Simply buying more tools and more technology isn’t the answer here.”

Gonzalez agrees with O’Reilly in that one clear answer when it comes to cybersecurity is a cultural one.

“Organisations that weather and thrive following a cyber incident have a strong culture of resilience, have invested in securing their networks and systems to do what they can to prevent a breach, and have prepared as best they can for an attack in this ‘when’, not ‘if’ environment.”

Another answer may be for businesses to simply collect less data on their consumers. In November, the government flagged a review of mandatory data legislation, passed in 2015, which requires telecommunication companies to hold customer information including names, call records and other data for two years. 

Attacks To Intensify

Ashwin Ram, cybersecurity evangelist at Check Point Software, says an organisation in Australia is being attacked on averaged nearly 700 times a week over the past six months.

He says it’s a mistake, however, to read the recent headlines about the St Vincent’s Health and Court Services Victoria hacks and assume that they are the work of a criminal mastermind. “There’s nothing sophisticated about these cyberattacks,” Ram says.

“These recent ones appear to be financially motivated, and cybercriminals are extorting as much as possible from their victims. Many attacks begin with some form of social engineering, such as the one against Court Services Victoria, where email was the delivery mechanism for initial access.

“The most common attack vectors include phishing, cloud misconfiguration, software vulnerabilities, and compromised credentials, as was the case in the St Vincent’s Health breach. ”

For Ram, it’s not the regularity of the attacks that is most worrying. It’s that cybercriminals also now have access to generative AI tools, allowing them to create highly effective phishing campaigns that are nearly impossible to detect.
Attacks to intensify

Ram and other cyber experts are predicting a further surge in cyberattacks over the next year given the rise in AI tools such as ChatGPT.

“Over the next year, cybercriminals will increasingly leverage generative AI to develop new tools for cyberattacks,” he says. “This trend will also lower the barrier to entry, enabling less technically proficient individuals to engage in malicious activities, as advanced skills are no longer a prerequisite for creating attack tools.”

More here:

https://www.smh.com.au/technology/low-cost-high-reward-the-hackers-holding-australia-to-ransom-20240105-p5evcg.html

It is a rather sad state of affairs that so early in the year we have to be reminded of the evil-doers out there and how we are really continuing to loose to war!

Each year the stakes are just that much higher and it really seems that we have reached some form or truce in the cyber war with the harm done being bad but not bad enough to provoke a really successful and sustained response!

I wonder will this be the year where AI and intelligent agents of some sort just clean up behind us and harm is reduced to an insignificant level permanently. I am sure such an outcome is in our futures. If not this year, some time soon!

David.

Thursday, January 04, 2024

It Has Really Been A Pretty Shaky And Sad Beginning To 2024.

This appeared earlier today.

Why the fates of Ukraine, Israel and Taiwan hang in the balance

Americans and Europeans truly have blindfolds on if they think they can raise their glasses to a happy new year while missiles rain down on Kyiv.

Niall Ferguson

Updated Jan 4, 2024 – 10.07am, first published at 5.00am

Twenty years ago, I published Colossus: The Price of America’s Empire. I had wanted to call it Blind Colossus: The Rise and Fall of the American Empire. In the still jingoistic atmosphere that had followed the terrorist attacks of September 11, 2001, my publisher dissuaded me. By the time the paperback came out, I could at least insist on my preferred subtitle.

Despite the passage of two decades, the book’s core arguments still stand up. Indeed, the tragic spectacle unfolding in Ukraine reminds me why I wrote the book in the first place. Americans – and Europeans, whose wealthy yet geopolitically inconsequential Union I also criticised – truly have the blindfolds on if they think they can raise their glasses to a happy new year while missiles rain down on Kyiv. Writing in 2003, I was not in principle against a pax americana in succession to the pax britannica of the 19th and early 20th centuries. I took (and still hold) the now heretical position that most history is the history of empires; that no empire is without its injustices and cruelties; but that the English-speaking empires were, in net terms, preferable for the world than the plausible alternatives, then and now.

However, I was sceptical about the neoconservative project to reorder the “greater Middle East” under the cover of a “global war on terror” in retaliation for September 11. I particularly doubted that the United States would be able to achieve its goals of transforming the governments of Afghanistan and Iraq into its allies – or at least satellites. Had Britain’s imperialists succeeded in taming the wild lands north of the Khyber Pass, much less ancient Mesopotamia?

The reasons for my scepticism were what I called the “three deficits” of America’s strange empire that dared not speak its own name. The first was the economic deficit – the federal government’s fiscally unsustainable path, which would make long-lasting military and administrative commitments abroad difficult to afford. More broadly, the United States was a net importer of capital and hence a massive global debtor, in marked contrast to Victorian Britain, which accumulated a vast stock of overseas investments. If you want to run the world, it helps to own much of it, rather than to owe it.

The second was the manpower deficit – unlike 19th-century Britons, most Americans have no great enthusiasm for spending large parts of their lives in far-flung hot, poor and dangerous countries. Consider the short tours of duty served by most military personnel who were deployed to Afghanistan and Iraq, not to mention the way many US bases tended to be cut off from the local populations.

Likewise bunkered in bomb-proof embassies, deficient in local-language proficiency, and wedded to first-world comforts, few American Foreign Service Officers have “gone native” in the past 20 years. They didn’t get the chance.

Finally, and most importantly, there was the attention deficit – the tendency of the American electorate (and therefore its elected representatives) to lose interest in any foreign enterprise that takes longer than a few years to complete. The prediction that the American appetite for reordering the Middle East would not outlast George W. Bush’s first presidential term proved correct. Barack Obama based his meteoric rise on not having supported the war and went on to tell the world that America was no longer “the world’s policeman”. (Syrians soon learnt what that meant in practice.)

All that has happened since 2003 has confirmed that the three deficits remain a powerful constraint on the exercise of American power abroad. The fiscal deficit now far outstrips what it was 20 years ago. The total federal debt was 59 per cent of GDP in 2003; last year it was double that (120 per cent). The manpower deficit today manifests itself as the armed services’ growing difficulty in finding willing, able-bodied recruits: At 452,000 active-duty soldiers, the US Army is the smallest it has been since 1940. Finally, the attention deficit disorder is now so severe that the public expresses impatience with wars it is merely being asked to support with money and material. No American has been obliged to fight to defend Ukraine against Russia’s criminal invasion. And yet, according to recent polling, nearly four in 10 Republicans think that “in terms of military support, America is already doing too much”.

Vastly more here and really excellent reading:

https://www.afr.com/world/europe/the-fate-of-ukraine-hangs-in-the-balance-20240101-p5eujb

It really seems that 2024 has started pretty badly and it is hard to be very optimistic right now!

On the Digital Health front I plan to wait a few weeks to see what interesting initiatives are announced for 2024 and what progress is reported for last year. Time will tell I guess…..

David.

Tuesday, January 02, 2024

There Is Little Doubt We Can Now Deliver A Lot Of Care Outside Expensive Hospital Environments!

This appeared late last year.
Why home is better than hospital

Patients can often be treated at home just as well as in expensive hospitals. But private health insurers have too little incentive to fund it. 

Jason Kara is chief executive of Catholic Health Australia

Jan 1, 2024 – 2.47pm

Modern hospital-in-the-home care is a generational game changer for the health system, offering huge cost savings and superior patient care.

So why is Australia missing out while the rest of the world roars ahead?

The answer is our private health insurance system. This isn’t to say that the private health insurance sector does not recognise the advantages of hospital in the home (HITH).

But the system as it stands allows individual insurance providers to try to manipulate the system to suit their respective individual corporate interests. This messy, piecemeal approach is stymying Australia’s progress.

On current projections, by 2025, when the UK expects to be treating 20 per cent of its patients at home, Australia will be lucky to hit 5 per cent. What we need is system-wide reform.

But before we consider how that can be done, it’s worth noting the true scope of the benefits we’re talking about.

HITH today uses modern technology, meaning there need not be any compromise in the standard of clinical care.

Hospitals can impose strict infection control standards and policies. They have rigorous incident reporting and management protocols.

HITH is not suitable for all types of care. But for a significant portion of the current hospital patient load – think chemotherapy, dialysis, wound care, and post-surgical rehab – it can offer superior health outcomes, often at a fraction of the cost.

If we take cellulitis as an example, the savings are about $970 per patient, per day.

Unfortunately access to home treatment for that patient is dictated by their insurer, not their doctor.

HITH also offers substantial advances in palliative care. Though the range of care treatment scenarios makes it difficult to carve out a specific dollar value, the Productivity Commission found the cost of avoiding a single hospital admission was enough to cover the cost of community-based palliative care for several months.

Yet, in Australia, the overwhelming majority of palliative care and cellulitis treatment still happens in bricks-and-mortar hospitals. Why?

The problem is that private health insurers do not have to offer HITH as a default benefit, as they do in-hospital care.

Often, a patient wants to be treated at home and their doctor believes HITH is appropriate. Unfortunately access for that patient is dictated by their insurer, not their doctor, and depends on the individual contracts their insurer chooses to sign with hospitals and other providers.

Many insurers do not support HITH services outside of those they are able to provide themselves, either directly or via a subcontractor.

Some insurers may cover more of the costs associated with HITH services if the services are provided by a preferred provider.

But if a patient chooses to receive HITH services from a non-preferred provider, their insurer may cover less of the cost or may not cover it at all.

The lack of default benefits for HITH is a severe barrier to its wider adoption. As things stand, there’s no real incentive for insurers to cover HITH services if those services are provided by non-preferred providers.

Healthcare providers, meanwhile, are obviously less likely to invest the time and resources required to develop and offer HITH services if they know most insurers won’t cover these services.

Two things need to happen to break the impasse.

The private health insurance lobby needs to recognise that the short-term desires of its individual members are at odds with the long-term health of the system. And the Department of Health and Aged Care needs to step up and bite the bullet on reform.

The health portfolio is not generally considered simple and reform is often devilishly tricky. But in this area, the path forward could not be clearer.

Private health insurers currently have to provide a range of default benefits, notedly for all care delivered to eligible members in hospital; HITH simply needs to be listed as a logical extension of this.

The new system should mean that if any insured patient is being treated for an eligible condition at any hospital where HITH is an option, if they and their clinicians decide HITH is right for them their health insurance would automatically cover it.

Catholic Health Australia commissioned independent economic modelling to identify the default benefit necessary. It found a default benefit of $330 per day would be sufficient to provide an incentive for hospitals and insurers to significantly expand clinically effective HITH programs for a range of conditions and episode types.

More here:

https://www.afr.com/companies/healthcare-and-fitness/why-home-is-better-than-hospital-20240101-p5euhr

Funny that this article does not mention the big driver in my opinion, patient preference. Given the chance many would far prefer their care to come to them and for their monitoring to be increasingly remotely enables, once over the acute issue. I know I sure would!

The problem is, of course, that delivery of this type of care is not as convenient for clinical care providers and so is typically less favoured by the powers that be! Changing this bias will require attitudinal change and improved technology that better links patients and their carers. Structured investigation into what remote technologies would be most useful would be very worthwhile!

I wonder what changes we will see over the next few years?

David.

Monday, January 01, 2024

AusHealthIT Poll Number 728 – Results – 1 January, 2024.

Here are the results of the poll.

How Are You Feeling About Digital Health Progress In 2024?

Positive                                                                         32 (43%)

Negative                                                                        41 (55%)

I Have No Idea                                                               2  (3%)

Total No. Of Votes: 75

Quite a close vote with a majority being a little negative. Would have been nice to see a little more optimism!

Any insights on the poll are welcome, as a comment, as usual!

A great number of votes. But also a clear outcome! 

2 of 75 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

Welcome To 2024 - I Hope It Is A Good One!

 Welcome one and all to the New Year!

While all sorts of platitudes are possible what I would really like to see over the next 12 months is some real accountability for the expenditure of Digital Health budgets so that, come December, we find the health system is working more smoothly and safely than at the start of the year and that better decisions are being made regarding patient care because of wider availability and better accuracy of the information carers can source and use.

Sounds simple, but it seems to be pretty hard but even small improvements would be welcome!

What would you most like to see as we move into 2024?

Happy, safe, successful and satisfying New Year to all!

David.

Sunday, December 17, 2023

Some Good News To Wrap Up A Rather Mixed Year!

This is a cheering piece of news to wrap up 2023! 

Cancer vaccine wards off recurrence for up to three years

By Natasha Robinson - Health Editor

Updated 6:50AM December 15, 2023,

The world’s first cancer vaccine has been found to prevent cancer returning in melanoma patients for as long as three years, new ­results from a major clinical trial show.

The cancer vaccine that has been developed by Moderna is now moving to phase 3 studies after the second tranche of data from the phase 2 study showed the stunning results.

The vaccine, which is dubbed mRNA-4157/V940, is a personalised mRNA vaccine that is given in conjunction with the immunotherapy drug Keytruda. It had already been found to reduce the recurrence of melanoma by 50 per cent in initial human trials when administered alongside the immunotherapy drug.

Now new data shows that among patients with resected high-risk stage III or IV melanoma, adjuvant treatment with the vaccine in combination with Keytruda continued to demonstrate a clinically meaningful improvement in recurrence-free survival for as long as three years. The prevention of cancer recurrence was found in the latter ­stages of the phase 2 trial to be as high as 49 per cent.

“The really important point is that we saw the maintenance of that benefit now out to three years, which gives us confidence that this substantial reduction in the risk of relapse is likely to be durable for a long time,” said Moderna president Stephen Hoge. “Therefore the potential for this therapy is as good as we hoped a year ago.

“I think it’s confirmatory that this really does have the potential to be a new approach to treating cancer patients, and across a wide range of cancers.”

Cancer vaccines are in their infancy and Moderna’s vaccine for melanoma patients is the first that has been developed. The technology was accelerated by Covid-19, when mRNA vaccines were widely trialled and proved effective. The technology is now being invested in heavily around the world, including in Australia which has established a number of research facilities and manufacturing plants.

Cancer vaccines are formulated to be specific to each patient’s cancer and are ­developed based on the individual’s tumour biopsies, which are then genetically sequenced. Scientists identify that person’s cancer cells’ specific mutations and create an mRNA vaccine that primes the immune system’s t-cells to target the ­mutated cells.

“This is an era of individualised medicine,” said Dr Hoge. “This is a medication that’s very different than anything else that’s been used, because you make it for one patient based on what their individual cancer looks like. We’ve always wanted to move down a path of individualised medicine, but this is a sign that we may be going down that path.”

Other cancer vaccines are now in development, including by brain cancer suffering and eminent pathologist Richard Scolyer and his colleague Georgina Long, who are using the melanoma technology and applying it to Professor Scolyer’s brain cancer.

Professor Scolyer announced earlier this year that he was “patient zero in what may become the new frontier of brain cancer treatment”.

Professor Long was a principle investigator in Moderna’s melanoma cancer vaccine. She emphasised the phase 2 study was a small study involving 157 patients and would now need to be replicated in a larger phase 3 trial, which has begun recruiting.

More here:

https://www.theaustralian.com.au/science/cancer-vaccine-wards-off-recurrence-for-up-to-three-years/news-story/26669a33cdea4fc3f86438e2b332bed9

Good news to wrap up the year I reckon.

Thanks to all have read and commented this year – and sorry for the service interruption what I was in Hospital and all that earlier in the year

Any comments on the year past or thoughts for the next year welcome.

A safe and happy festive season to all.

Back some time in January fate willing!

David.

AusHealthIT Poll Number 727 – Results – 17 December, 2023.

 Here are the results of the poll.

Have You Begun To Explore What Generative AI May Be Useful For In Your Profession / Role?

Yes                                                                                  12 (67%)

No                                                                                    6 (33%)

I Have No Idea                                                                0 (0%)

Total No. Of Votes: 18

Interesting so many are having a look at Generative AI and its possible applications!

Any insights on the poll are welcome, as a comment, as usual!

A poor number of votes. But also a very clear outcome! 

0 of 18 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those very few who voted! 

David.